Endodontic treatment has evolved greatly over the last two decades and has a high success rate when performed apropriately. The goal of endodontic treatment is the three dimensional cleansing, shaping, and obturation of the canal space from the canal orifice to the minor constriction of the apical foramen. It is generally considered that the single most important success factor in endodontic treatment is root canal preparation — the cleansing and shaping of the root canals prior to obturation. The mechanical shaping of root canal systems has been accomplished with a wide variety of methods and instruments. Canal instrumentation by hand was the first technique to be implemented and is still used today. Rotary nickel titanium (RNT) files became commercially available in the early 1990s for canal enlargement, and today RNT methods predominate in the developed world and among specialists. The use of RNT has enabled more centered canal preparations and fewer canal aberrations during preparation compared to previous techniques, and is efficient, systematic and safe when used appropriately. Depending on the design of RNT files, they can be more or less efficient and more or less resistant to breakage. File fracture can be the result of the properties of the alloy itself, and/or the clinician’s technique. RNT files are available as traditional ground nickel titanium files and as twisted files (TF). TF are the first RNT that can be efficiently and safely used as a single file technique, and offer different physical properties to traditional ground RNT. Regardless of the method and technique selected, the clinician must use an appropriate technique and great care when performing endodontic procedures.

Endodntics have evolved as a truly scientific procedure and, when correctly diagnosed and performed, its research-reinforced statistics corroborate its high success rates. In order for a correct diagnosis to be made, a number of steps and tests are required. These include ascertaining the source of the patient's chief complaint, understanding the patient's dental history and performing pulp tests that are integral to the diagnosis. In addition, the possibility of cracked teeth and periodontal involvement must be considered and assessed during the diagnostic phase. Only after a complete examination has been performed and a definitive diagnosis obtained is it possible to create a treatment plan for successful endodontic treatment.

Endodontic treatment has as its overall goal the long-term retention and restoration of the endodontically treated tooth, including an absence of periapical infection. For this to be achieved, a number of steps and a careful technique are required during instrumentation and irrigation for cleansing and shaping of the canals, and during root canal obturation. Over time, root canal instrumentation options developed to include NiTi reamers and files, Gates Glidden drills, and other designs for manual and rotary use. Instrumentation options and techniques for obturation also increased to include traditional lateral and vertical cold condensation techniques, as well as techniques utilizing carriers and new materials. Regardless of which combination of instrumentation and techniques is used, successful endodontic therapy relies on a number of sequential steps that must be thoroughly carried out.

Cone beam computerized technology (CBCT) offers 3-dimensional visualization and more complex and more accurate imaging compared to analog and digital radiographs. It is an accurate tool for many clinical oral-maxillofacial indications, with lower radiation doses than computerized tomography. The clinician must determine the risk:benefit of imaging for each patient. Clinicians are rapidly realizing the significant advantages of CBCT imaging. Factors to consider in determining whether to purchase a CBCT device or to refer patients to imaging centers include cost, training, time required to generate images and reports, data transmission and storage, and responsibility for interpretation and pathology review.